Surgery Of The Urethra Flashcards
What is the most common developmental abnormality of the male genitalia?
Hypospadias —> incomplete formation of penile urethra
—> urethral orifice can occur along anywhere along penis
Dogs predisposed to hypospaidas?
Boston terrier
Signalment associated with urethral prolapse ?
Young brachycephalic male
Ex unknown
-sexual excitement/dyspnea/infection
Clinical signs of urethral prolapse?
Bleeding from prepuce
Licking
Red-purple mass
What is the treatment for a prolapsed urethra that is necrotic or ulcerated?
Resection and anastomoses
—> catheterize
—> tourniquet (keeps penis extruded, controls bleeding)
—> 180 degree incision (prevent mucosal retraction )
—>suture
What suture should be used for urethral surgery ?
Monofilament (eg PDS)
Avoid braided
What are the pros and cons to catheter placement in urethral surgery?
Pro - divert urine
Con - comprise healing and narrows lumen
Where can you have urine accumulation due to urethral trauma?
Abdomen, pelvic canal, or SQ tissue
What are clinical signs of urethral trauma?
Hematuria
Stranguria
SQ or abdominal fluid
Azotemia
How can you diagnose urethral trauma/tears?
Positive contrast urethrogram
Treatment for urethral tears?
Incomplete/small lacerations will heal with urinary diversion with catheter or cystostomy tube
Duration of catheterization is dependent on severity - minimum 3 weeks
Urethral is completely ruptured.. how to treat?
Anastomosis or repair with urinary diversion
Common place for urethral stones in males?
Ischial arch/cd penis
Stones
Goals of treatment for urethral obstruction?
Renal function/uremia
Electrolytes —> often have metabolic acidosis and hyperkalemia (give hypertonic NaCl)
Temporarily relieve obstruction
- catheter
- hydropropulsion
- cystocentesis
Treat UTI
Prevent reoccurrence
When is surgery indicated for urethral obstrucion?
Multiple episodes
Urethral damage
Stricture formation
Cystotomy after hydropropulsion
Urethrotomy if hydropropulsion unsuccessful
Often cystotomy combined with urethrotomy
Indications for urethrotomy?
Calculi that cannot be hydropropulsion
Cystotomy preferred
What is the most common location for a urethrotomy in dog?
Prescrotal
Where do you make your incision for a prescrotal urethrotomy?
Ventral midline between base of scrotum and caudal penis
What muscle must you retract in prescrotal urethrotomy?
Retractor penis muscle
Why is prescrotal urethrotomy preferred to other sites?
Less risk of hemorrhage -> less cavernous tissue
This is common site of obstruction
What size and type of suture will you used to close urethrotomy?
4\0 or 5\0 monofilament absorbable
Why might you want to allow your urethrotomy site to close by second intention?
Less risk of stricture
What approach would you do if your calculi are lodged between scrotum and ischial arch?
Perineal urethrotomy
Why do we want to avoid perineal urethrotomy?
Difficult procedure —> deeper urethra, past bulbospongiosus m and corpus spongiosum
Increase risk of infection (under anus)
Have to suture urethrotomy incision
What is a urethrostomy??
Forming a permanent opening of the urethra at a new site
Indications for a urethrostomy ?
Permanent damage
Recurrent urethral obstruction
Obstruction that cannot be retropulsed or moved by urethrotomy
What are possible urethrostomy locations for dogs?
Scrotal (preferred)
Prescrotal
Antepubic
Perineal
What are locations for urethrostomy in cats?
Perineal
Antepubic q
